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The range of psychiatric facilities includes psychiatric hospitals, psychiatric and neuro-psychiatric nursing units of general hospitals, facilities for the psychiatric medically infirm, gero-psychiatric units, alcohol and drug addiction treatment facilities (both inpatient and outpatient), mental health clinics, day hospitals, day treatment centers, and others.
In addition to inpatient nursing units, psychiatric hospitals include their associated diagnostic and treatment areas, as well as the necessary dietetic, supply, housekeeping, and administrative spaces common to all hospitals. They do not generally include the complex and high-tech diagnostic and treatment areas of general hospitals.
Psychiatric hospitals may include outpatient psychiatric areas. These areas should be located on a direct path from the lobby, and circulation paths of the outpatients should be separated from the paths of the more acutely ill inpatients. Teaching hospitals will also include spaces for training and education, and often spaces for research studies.
Psychiatric Facility, VAMC Augusta, GA
The mental health clinic is the basic outpatient unit, providing an interface between inpatient care and the community. As such, it provides preventative care, primary care, and aftercare. The clinic may also serve as a site for research and for training of mental health professionals on all aspects of outpatient treatment of mental health problems.
A substance abuse clinic provides outpatient care and treatment of alcohol and/or drug-dependent patients no longer needing inpatient care. In a hospital, it should be so located that its patients do not need to travel through other parts of the hospital.
The day hospital has no beds, but is typically located within or adjacent to a hospital. It offers total hospital psychiatric services for acutely ill patients without removing them from the family and community.
The day treatment center provides a supportive learning environment away from a hospital in which patients having chronic difficulties with community adjustment and other psycho-social problems may receive help. Such patients have often had long periods of hospitalization, and need continuing monitoring of their general health and medication needs.
Efficiency and Cost-Effectiveness
The design of a successful psychiatric facility should:
- Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces
The character of the immediate surroundings can have a profound affect on the psyche of a psychiatric patient. The New York Psychiatric Institute reports a dramatic drop in the number of patients who need to be restrained since occupying their new facility with its bright open spaces. Every effort should be made to create a therapeutic environment by:
- Providing access to kitchen facilities, preferably on the unit, where snacks or meals can be prepared by patients, when patient profile allows.
Gero-Psychiatric Facility, VAMC Salem, VA
Psychiatric facilities should be easy to clean and maintain. This is facilitated by:
Aesthetics is closely related to creating a therapeutic environment. It is also a major factor in a facility's public image and is thus an important marketing tool for patients and staff. Aesthetic considerations include:
- Use of new lighting systems, high performance glazing, increased use of natural light, natural materials, and colors
- Use of (soothing, not exciting) artwork
- Attention to details, proportions, color, and scale
- Bright and open public and congregate spaces
- Comfortable and intimately scaled nursing units and offices
- Compatibility of exterior design with surroundings
The potential suicide of patients is a special concern of psychiatric facilities. The facility must not unwittingly create opportunities for suicide. Design to address this and other safety and security issues includes:
- Solid material specified ceilings
Psychiatric facilities are public buildings that may have a significant impact on the environment and economy of the surrounding community. As facilities built for "caring", it is appropriate that this caring approach extend to the larger world as well, and that they be built and operated "sustainably".
Section 1.2 of VA's HVAC Design Manual is a good example of health care facility energy conservation standards that meet EPAct 2005 and Executive Order 13693 requirements. The Energy Independence and Security Act of 2007 (EISA) provides additional requirements for energy conservation. Also see LEED's (Leadership in Energy and Environmental Design) USGBC LEED for Healthcare.
The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information, paper and electronic, as well as patient accommodations."
There is a continuing shift to outpatient psychiatric care as new and more effective drugs are developed for the classic psychiatric conditions. Many of the homeless in our urban areas are ex-psychiatric inpatients who receive little or no follow-up outpatient care. There is a large unmet need for supportive housing and/or treatment facilities for them.
There is also a great need for effective treatment of drug addiction and alcoholism, particularly among the poor. This issue is also related to homelessness.
Relevant Codes and Standards
Health care facilities are among the most regulated of all building types. Like other buildings, they must follow the local and/or state general building codes. However, federal buildings on federal property generally need not comply with state and local codes, but follow federal regulations. To be licensed by the state, design must comply with the individual state licensing regulations. Many states adopt the AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities, as a resource, and thus that volume often has regulatory status.
State and local building codes are based on the model International Building Code (IBC). Federal agencies are usually in compliance with the IBC except NFPA 101 (Life Safety Code), NFPA 70 (National Electric Code), and Architectural Barriers Act Accessibility Guidelines (ABAAG) or GSA's ABA Accessibility Standards takes precedence.
Facilities which treat patients who are reimbursed under Medicare must also meet federal standards, and to be accredited, they must meet standards of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Generally, the federal government and JCAHO refer to the National Fire Protection Association (NFPA) model fire codes, including Standards for Health Care Facilities (NFPA 99) and the Life Safety Code (NFPA 101).
The American with Disabilities Act (ADA) applies to all public facilities and greatly the building design with its general and specific accessibility requirements. The Architectural Barriers Act Accessibility Guidelines (ABAAG)
Federal agencies that build and operate psychiatric facilities have developed detailed standards for the programming, design, and construction of their facilities. Many of these standards are applicable to the design of non-governmental facilities as well. Among them are:
- Department of Veterans Affairs(VA), Office of Construction & Facilities Management Technical Information Library contains many guides and standards, including:
- Design Manuals of technical requirements, equipment lists, master specifications, room finishes, space planning criteria, and standard details.
Products and Systems
See WBDG Health Care Facilities for generic health care facilities websites
- Design Considerations for Mental Health Facilities by AIA Committee on Architecture for Health. Washington, DC: AIA Press, 1993.
- Design Details for Health: Making the Most of Design's Healing Potential, 2nd Edition by Cynthia A. Leibrock and Debra Harris. New York: John Wiley & Sons, Inc., 2011.-Innovative design solutions in key areas such as lighting, acoustics, color, and finishes
- Psychiatric Services-Journal of the American Psychiatric Association primarily focused on treatment of mental illnesses, but carrying occasional articles dealing with facilities.
- Sound & Vibration: Design Guidelines for Health Care Facilities by the Acoustics Research Council. 2010.
- UFC 4-510-01 Design: Military Medical Facilities
- See WBDG Health Care Facilities for generic health care facilities publications